I have read two articles today one by Ackoff (see posting on Ackoff and his sayings) and one by Churchman “Managerial Acceptance of Scientific Recommendations.” California Management Review 7.1 (1964):31-38. Both explore the concept that there is a certain dissonance which could contribute to failure of a systems on the design and implementation of that system. There is a need to those involved in the management and implementation of a system, and not just an information system, should also be involved in its design. As Churchman states ” we must understand the process by which the whole world becomes focused on certain issues and aspects of his environment. ” Once again it is the external environment of an organisation that plays a pivotal role in the success/failure of a system.
If you then apply that to NHS Direct then the constantly changing environement of the NHS will have been instrumental as to whether NHS Direct is viewed as a success or failure. The NHS is a large and very complex organisation with a number of ‘organisaitonal ecosystems’ within it. Therefore, one would expect that some PCG would have a different relationship than others.